Stop illicit trade of tobacco products

Carolyn Kavita Tauro, CNS Special CorrespondentTobacco kills 6 million people annually of whom more than 600,000 are non-smokers dying from passive smoking. More than 80% of these preventable deaths in the future will be among people living in low-and middle-income countries. According to 5th edition of The Tobacco Atlas 2015, compared to other higher tobacco consumers, India has 106 million (>20%) adult males smoking daily (2013). India and China have 12.2 million daily females smokers, second only to US, which has 17.7 million.
As per the Global Tobacco Report 2012, cigarette use among adolescents in India is only 4.4% compared to the overall tobacco use of 14.6%2. Smokeless tobacco is consumed by more than 20% of its total adults - one of the highest in the world along with only Myanmar, Bangladesh, Nepal and Madagascar.

Why is tobacco a health concern?

Tobacco consumption is more and more a health issue as the number of mortalities and morbidities considerably increases with each cigarette smoked. According to 5th edition of The Tobacco Atlas, tobacco smoking is the cause for 50%-69.9% deaths in India alone (2010)4. Tobacco smoking can lead to compromised lung functions that are susceptible to many other disease such a tuberculosis, with associations with cancers of many other organs besides the lungs. Smokeless tobacco, such as water pipe smoking (hookah), has also shown association with oesophageal and gastric cancers in India and Iran4. The tobacco products lure youth into experimenting with tobacco who use it because they are affordable. Unlike other lethal products, illicit ones do not have health warnings, thus misleading young people into not only using them, but also selling them.

New Protocol against Illicit Tobacco Trade

The WHO Framework Convention on Tobacco Control (WHO FCTC) was the first international health treaty negotiated by the WHO, that entered into force on 27 February 2005 and 180 countries (the last one being Zimbabwe) have signed it so far. The WHO, on World No Tobacco Day this year (2015), advocates to “Stop illicit trade of tobacco products” calling on all the Parties to the Convention to sign the "Protocol to Eliminate the Illicit Trade in Tobacco Products"5. While 8 countries have already done the needful, at least 32 more need to ratify this protocol to make it an international law.

One in ten cigarettes and tobacco products consumed globally are illegal5. Although illicit trade is highest in Europe, it is not a problem of high-income countries alone and affects almost all countries in one form or the other. In response to the threat posed by illicit tobacco trade, the international community negotiated and adopted in November 2012 the Protocol to Eliminate Illicit Trade in Tobacco Products, the first protocol to the WHO FCTC. India was the fourth biggest market among 24 countries for illicit cigarettes with about 20,905.5 million illicit cigarettes consumed (21.5% of the duty paid market, 2010).

Factors that influence illegal trade include weak governance, cross border issues, participation of industries, well-organised crime networks, informal distribution channels and corruption levels.
Many countries have passed good tobacco control laws. India had taken giant steps towards tobacco control by setting an example through the Indian Supreme Court ruling in 2012 that declared gutkha and pan masala (chewing forms of tobacco) perilous food products, banning them under the Indian food safety law. Tobacco companies have been known to use loopholes in tobacco control governance systems and indulge in illicit trade of tobacco products.

Dr Tara Singh Bam, The Union

Furthermore tobacco industry uses many a loopholes to influencing governance systems. “In Nepal, although a comprehensive tobacco control law had been passed in 2011, actual enforcement could take place in 2014 only due to the persistent tobacco industry tactics in the country,” said Dr Tara Singh Bam, Technical Advisor on tobacco control to Nepal and Indonesia, at the International Union Against Tuberculosis and Lung Disease (The Union). Donations from tobacco industry in countries where it functions continue to promote a product that is lethal. In countries with a large number of smokers, over USD 1 million is spent by tobacco industry towards donations. In India between USD200,000-500,000 was spent between 2009-2013 by one of these companies. Countries which have banned funding from tobacco companies for tobacco prevention programs include Columbia, Uruguay, Namibia, Libya, Ukraine, Iran and Mongolia.

Challenges and Progresses towards tobacco control

Dr Ehsan Latif

According to Dr Ehsan Latif, Director, Tobacco Control Department of The Union, “There are many challenges that face good tobacco control. One of these is lack of existing good infrastructure without which law enforcement is impossible; use of existing infrastructure should be adequate help carry out good control measures. Other challenges include cross border advertisement picked up by signals across borders, movies depicting smoking and a constant struggle for capacity building to make tobacco control sustainable despite low funding. 1.1 billion people are today covered under smoke free legislation across the globe. Different cessation models including integrating with facilities like TB and asthma clinics and good laws such as those passed by countries such as Indonesia, Argentina and China recently are of great benefit”.

Another important tobacco control measure is printing of gruesome graphic/pictorial health warnings on tobacco packs and/or plain packaging by countries such as Australia and the UK, and in South Asia, particularly Nepal and Pakistan where graphic health warnings cover 85% to 90% of the packaging. A recent study conducted by Civil Society Action Nepal, in nine districts of Nepal, found that 93.8% of the respondents had noticed public health warnings on cigarette packs in the past 30 days, 90.3% of whom said it made them think about the harmful effects of smoking; 82.1% of whom were current smokers).

Illicit trade in tobacco undermines tobacco control measures like high taxes and prices, by bringing down prices, that results in affordable tobacco products1. High prices protect the poor and vulnerable, especially the young, who cannot keep up with price elasticities, needing to work harder to afford their cigarettes, hence decrease their tobacco consumption and increase their rate of quitting.

“High taxes do not lead to illicit trade”, says Latif, “It is the manufacturers, along with weak governance, that does. Illicit trade through cheaper cigarettes that costs the government dearly should not be allowed”.

When sale of tobacco is rendered illegal, still lesser people will have daily access and the younger ones further still if good governance ensures this. In Spain, the anti-smuggling legislation and higher penalties on smugglers pushed the illicit market share from 15% to 2% in Italy and 6% in Spain. Further measures like additional customs officers, X-ray scanners, tougher sanctions, public awareness campaigns, supply chain legislations and confiscation may help in the strategy towards tobacco control1. “Tax collected can be used to not only fight tobacco use but also to fund the government’s public health and awareness programmes including non-communicable disease (NCD) programmes”, continued Dr Latif.

Goals of the WNTD 2015 campaign
• Raise awareness on the harm to people’s health caused by tobacco products
• Show how health warnings are undermined
• Demonstrate the illicit trade of tobacco products
• Show how criminal groups profit
• Promote the "Protocol to eliminate illicit trade in tobacco products”

“We are still far from discussing strategy and planning towards tobacco control. We should be several steps ahead in anticipation of what the industry will be up to so that we have a solution before we are face to face with the problem”, Dr Ehsan Latif pointed out. Policy makers need to realise that illicit tobacco trade has security implications of financing organised crimes apart from its effect on a global epidemic and health concerns, and ratify the protocol to address these needs. The public should recognise the ill effects of tobacco consumption on health, economic as well as social aspects of life, and join hands with governments in campaigning against the illicit trade of tobacco through various media such as televisions, radios and the internet. Academics are called to conduct research on this subject to document its negative impacts along with the impact on health, economics and criminal activities when curbed. Carolyn Kavita Tauro, CNS Special Correspondent31 May 2015